Dental insurance cost and coverage basics

Generally, you can choose from three basic types of dental insurance plans. When you’re looking for dental coverage, consider what your most important factors are (like cost, keeping your dentist or flexibility). Then look at dental plans that would work for you and your situation. UnitedHealthcare-branded dental insurance plans from Golden Rule Insurance Company are Dental PPO plans.

Dental indemnity plans

This traditional fee-for-service insurance offers the most freedom of choice. Dental indemnity plans generally have:

• Higher premiums than a Dental HMO or Dental PPO
• Coinsurance. Just like Dental PPOs, there are certain percentages of costs you and the insurance company pay for different dental services.
• A small deductible you must meet
• A calendar year maximum to your benefits
• No network of providers. You’ll get the same benefits with any dentist you choose, but there are no network-negotiated discounts on dental services.

Dental HMO

Dental HMOs (Health Maintenance Organizations) generally have:

• Lower premiums than a Dental PPO or an indemnity plan
• Copays (standard fixed costs) you will spend for office visits and specific dental services
• No benefits for going to out-of-network dentists or providers
• No annual maximum to the benefits the plan will pay
• A restricted network of dentists and dental providers

Dental PPO

Dental plans underwritten by Golden Rule Insurance Company are Preferred Provider Organization (PPO) plans. With a Dental PPO, you generally find:

• Higher premiums than a Dental HMO
• Coinsurance, which is a percentage you and the insurance company pay for different dental services. For example, many Dental PPOs cover 100% of preventive services like exams and cleanings. But they may pay only 50% for major expenses like crowns or bridges.
• A calendar year maximum to your benefits (varies by plan)
• A network of dentists or providers with prenegotiated discounted services, which can help you save money
• Some benefits paid to out-of-network dentists or providers you might choose to use

The cost of dental insurance depends on a variety of things. It comes down to the plan you choose and the level of coverage it offers. With some plans, you may pay more up front and less when you get services. With other plans, the opposite may be true. Here are 4 factors that can help you understand the costs:

• Premium: The amount you pay every month to have coverage.
• Deductible: This is the out-of-pocket amount you pay for services covered by your plan before your insurance company pays.
• Coinsurance: The percentage of covered expenses you pay after you meet your deductible. For example, you could have 30% coinsurance for a filling. If the network cost of the filling is $100, you would pay $30 of that. Your insurance would pay the rest, up to your annual maximum.
• Copay: Under some dental plans, you might pay a fixed cost for certain services, like X-rays.

Shop dental plans and compare prices

Most dental insurance plans have a maximum benefit (limit to the amount they’ll pay) for the year. For dental plans underwritten by Golden Rule Insurance Company, there is an annual maximum from $1,000 to $3,000, depending on your plan.¹

No, the ACA does not require dental care for adults. You will not face a tax penalty if you don’t have dental insurance.

If you have children, the ACA requires that dental insurance must be available for your child. However, you don’t have to buy it. If you do choose to buy dental insurance for your child through the ACA, you aren’t required to buy coverage for yourself.

Golden Rule Insurance Company has a variety of dental plans. Options range from budget-friendly to plans with more comprehensive coverage. Compare dental plans and prices to find the right plan for you.

Yes. It is standalone coverage. You do not need a major medical plan to buy a dental plan.

Most dental plans include coverage for preventive care like routine exams, cleanings and X-rays. Some plans require a copay for preventive services, while others cover those services 100%. Many dental plans also include coverage for basic services like fillings and extractions, and major services like root canals, crowns and more.

Yes. Most plans cover dental services like fillings, extractions and root canals. Services covered and how much insurance will pay varies by plan. Make sure to review all the details of a dental insurance plan before you buy.

It depends. Some plans cover braces and orthodontic work, but not most. If that’s one main reason you’re shopping for dental coverage, you’ll want to look carefully to find a dental plan with that benefit. When you find one, make sure to read all the plan details.

It depends on your plan. A basic coverage plan (preventive care, simple fillings and extractions) typically won’t cover implants. Some dental plans with coverage for major services will likely pay for a percentage of implant costs. You’ll pay the rest out-of-pocket. How much depends on your plan’s coverage level and annual maximum coverage amount.

It depends. There is typically no waiting period for preventive services once you become covered. This means as soon as you purchase dental insurance, you’ll be able to use the preventive care benefits. Some plans have no waiting period for all types of care. Other plans may have a waiting period of 4 to 12 months for basic and major services.

The short answer is cost and convenience.

Network dentists agree to accept a lower negotiated rate on services. This means you pay less before your insurance company pays for anything.

Out-of-network dentists can bill a patient for any remaining amount up to the billed charge. Also, some dental insurance plans don’t pay any benefits to out-of-network dentists, or pay less.

When you use network providers, you usually don’t have to submit claims yourself. The dental office will handle the paperwork, saving you time.

It’s a good idea to check how many network dentists are in your area before you buy a dental plan. If you already have a dentist, be sure to confirm they are part of the plan network. Choosing a network dentist may help make your dental care more affordable.

Yes. Dental Gen plans are designed for adults age 64 and older. For more details, view the Dental Gen product brochure and call 1-800-273-8115 for sales assistance. Product availability varies by state.